Cliffhanger at MLK

WHEN 14-YEAR-OLD YESENIA PONCE wished her dad Happy Father’s Day last Sunday, she could think only about how she might have lost him forever. “Ever since I was a little girl,” she says, “I’ve dreamed of dancing the first dance with my dad at my quinceañera [coming-of-age party]. But when that whole thing happened at the hospital, I got really scared that he wasn’t going to, you know, be there.”

Her father’s battle to get emergency treatment for a life-threatening brain tumor at Martin Luther King Jr.–Harbor Hospital in February set off multiple investigations after the L.A. Weekly began asking questions about why Ponce languished in the ER for four days, finally fleeing to Harbor-UCLA Medical Center, where doctors acted quickly to save his eyesight.

Now, Ponce’s story (see L.A. Weekly, May 25–June 1, 2007), along with the Los Angeles Times–reported death of 43-year-old Edith Isabel Rodriguez, who died writhing in pain on the ER waiting-room floor, is at the eye of a political hurricane that threatens the survival of the beleaguered facility.

Yet another storm hit Tuesday with a report released by the Los Angeles County Health Services, citing a new investigation by the U.S. Centers for Medicare and Medicaid Services that found that MLK recently “failed to ensure the timely provision of emergency services for 17 out of 60 patients sampled.” Statistically speaking, this means 28 percent of patients who walk through MLK’s emergency-room doors on any given day could be met with what federal investigators described as a health-threatening “systematic failure.”

The hospital was already on shaky legs after it failed a federal inspection in September that almost cost it $200 million in federal funding and its accreditation. Financial catastrophe was temporarily averted when county health chief Dr. Bruce Chernof promised the feds he would slash beds and staff and place MLK under the control of the respected Harbor-UCLA hospital.

In effect, MLK was to be rebuilt while remaining open. The county hired new managers, spent millions on consultants and — it was believed — reassigned most staff to other facilities while retraining the rest.

But then, the Ponce and Rodriguez incidents made headlines, and federal health officials conducted a brand-new multiday inspection. Their harshly worded report on June 7 slapped a federal citation on MLK for “deficiencies” in the Rodriguez death and stated that its staff’s mishandling of Ponce shows that emergency-room patients at MLK face “imminent risk.”

The feds gave MLK 23 days to get its act together or lose federal funding forever, a cliffhanger deadline that expires on June 30.

As the Weekly reported, Ponce on February 28 was taken by his brother to the emergency room because of headaches so excruciating he could barely walk. Doctors diagnosed acute obstructive hydrocephalus — a condition produced by a brain tumor that acted like a boulder blocking a river, causing a dangerous buildup of fluid in his cranial cavity.

MLK doctors told Ponce he needed immediate surgery to drain the fluid, but the drastically scaled-down MLK couldn’t do it, so Ponce would be transferred. He was told not to eat, since surgery was all but imminent.

Instead, Ponce languished at MLK for four days, unable to get answers about his transfer or treatment even as his symptoms escalated: One side of his face went numb, he started vomiting intermittently, and he saw sparks of light in his field of vision. According to experts, his vision abnormalities were a red flag indicating that obstructive hydrocephalus was likely causing permanent damage, including blindness.

IT WAS THE TEENAGE YESENIA who indirectly saved her father. A ninth-grader at Animo Ralph Bunche Charter High School, where her teachers say she earns all A’s and B’s, Yesenia told a teacher about her dad’s situation, and the teacher suggested involving Bunche’s community-outreach coordinator, Abby Soto. With Soto’s help, the family signed Ponce out against MLK doctors’ advice and drove him to Harbor-UCLA, where he underwent surgery within hours. Since then, his eyesight has slowly returned to normal. His malignant tumor has required a second surgery and radiation.

Although the Weekly made repeated calls to MLK and the Department of Health Services, county officials initially offered this sole response: “The hospital and the department have fully reviewed the clinical facts of the case and determined that the care provided at MLK-Harbor Hospital was appropriate and consistent with a non-emergency.” But by June 12, after Ponce’s plight made headlines, Chernof told the Los Angeles County Board of Supervisors that the case “had numerous problems.”

Now, as MLK hurtles toward June 30, critics are asking how this hospital — overseen by a raft of highly paid consultants and managers, its beds reduced from over 200 to 42 — could continue to make such ghastly mistakes.

Last week, L.A. County Supervisor Gloria Molina pressed her fellow supervisors to prepare for MLK’s possible shutdown. “We are playing Russian roulette with everybody that is right now waiting in that emergency room,” she announced.

Molina is, of course, a member of the powerful five-member board ultimately responsible for cleaning up MLK, and, despite the board’s plans and promises, it has obviously failed to do so. At a June 18 meeting, county health officials stunned the board, admitting that they have not undertaken many of the sweeping changes they promised last fall, including transferring and retraining MLK’s staff and handing significant oversight to Harbor-UCLA. “We’ve poured tons of money and tons of energy into this hospital,” a source close to the board said. “People don’t understand why we’re still having incidents like these two.”

Critics say the Board of Supervisors has not come down hard enough on MLK, because every previous threat to shut down the hospital has been greeted by loud and prolonged objections from the African-American community. Yet, in the wake of Ponce’s experience and Rodriguez’s death, once-vocal black-community members and organizers have grown notably silent. “We expected an outcry,” says the county source, “but we honestly haven’t had one.”

Najee Ali, a South Los Angeles activist and director of Project Islamic H.O.P.E., and in the past a fiery MLK supporter, says the two high-profile incidents have “made it very hard to defend Martin Luther King hospital. That’s the real reason there’s no outcry.” Behind closed doors, Ali says, sentiments among many in the black community have changed. “You hear people saying that maybe it does need to be closed down for a while and then reopened,” he says. “It’s just nobody wants to come out with it publicly. But I live in that neighborhood, and I think it needs to be said. I know I’ve lost confidence. A lot of people have.”

In an effort to keep the feds from pulling the plug, the county on June 15 issued a detailed “Plan of Correction” regarding Rodriguez’s death. Then on June 18, the county issued a second correction plan, after the feds probed Ponce’s four-day ordeal and other incidents and concluded that ER patients at MLK face “immediate jeopardy.”

Both plans call for yet another round of retraining, plus new regulations and monitoring. But critics question whether training and extra rules can make much difference, when six hospital staff members ignored Rodriguez as she vomited blood, or when multiple physicians and nurses failed to follow existing regulations as Ponce suffered textbook symptoms of a man about to be blinded — or worse.

THESE INCIDENTS, and the alarming new failures detailed in Tuesday’s federal report, occurred in a hospital that is supposedly the most aggressively monitored in Los Angeles.

“At this point, it starts to seem like indifference among some of the medical staff,” concedes Ali.

Chernof, the reigning health official, vehemently disagrees. He says the Ponce and Rodriguez incidents are “tragic” and “not appropriate” but insists that “tens of thousand of patients are being treated . . . professionally and with care.”

“We can’t afford for this hospital to be closed,” says Chernof. “It’s much too important to the surrounding communities. And we expect the hospital to stand up and meet the standards that the [federal regulators] expect and that the community expects.”

And what if it doesn’t? “It will,” Chernof says. “It has to.”

Whether Chernof is wrong or right, one unalterable fact remains: In a city with an already overburdened health system, Martin Luther King Jr.–Harbor Hospital served 48,000 people just last year. If the authorities shut it down, nobody knows where all those patients will go.